Identify whether pain is likely neuroplastic

Before practicing somatic tracking, determine whether the pain fits the profile of brain-generated rather than structural pain.

Why it works

Somatic tracking works specifically for neuroplastic pain — pain generated by a sensitized nervous system that has learned to alarm rather than by active tissue damage or a structural condition requiring medical treatment. Applying tracking to structural pain (herniated disc with active nerve compression, inflammatory arthritis) is not appropriate and could delay necessary care. Identifying the likely source of pain is a precondition for safe practice.

How to do it

1. Check: has the pain been medically evaluated and cleared of structural cause? If not, start there.
2. Look for neuroplastic indicators: pain that moves or changes, spreads symmetrically, flares with stress or emotion, persists despite normal imaging.
3. Note whether the pain began during or after a period of psychological stress, not only physical injury.
4. If uncertain, discuss with a clinician familiar with pain neuroscience before proceeding.

Evidence

The neuroplastic pain model is consistent with neuroimaging research showing altered central nervous system processing in chronic pain; the BOULDER RCT specifically selected participants with chronic back pain and normal or minimal structural findings. (rct)

The BOULDER trial targeted a specific chronic back pain population; generalization to other pain types should be made cautiously and with medical input.

Sources

• Ashar et al. (2022), BOULDER trial — PRT vs placebo and usual care for chronic back pain, JAMA Psychiatry

Common mistake

Applying somatic tracking to pain that has an active structural cause without medical evaluation, which can delay appropriate care. Neuroplastic indicators are useful but not diagnostic — medical clearance matters.